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目的淋巴结血管肌瘤性错构瘤(AHL)罕见,为提高对本病的认识,对1例淋巴结血管肌瘤性错构瘤进行探讨。方法对肿瘤进行组织病理学特点观察,行免疫组化染色以及Masson三色染色和银染色,并结合文献复习讨论。结果镜下淋巴结部分结构尚存,可见少量淋巴窦和淋巴滤泡及散在灶性聚集的淋巴细胞,残存的淋巴组织多位于淋巴结被膜下或边缘区。淋巴结实质被血管、平滑肌和纤维组织取代,但无富于细胞的纤维束或平滑肌束形成。淋巴结门部有大量增生的厚壁血管,并向实质内延伸,延伸过程中血管壁由厚变薄,血管腔逐渐变小,在血管周围可见增生的平滑肌细胞围绕。部分间质纤维组织增生,伴有胶原化,可见较细的胶原纤维束,其纤维母细胞与增生的平滑肌有时不易区分。免疫组化:血管内皮细胞CD34(+),血管外周梭形细胞束SMA和desmin(+),HMB45、ER和PR(-)。Masson三色染色:胶原纤维和黏液呈蓝色,分布在胶原纤维间不成束的肌纤维呈红色。银染显示有残存的淋巴组织网状纤维。结论该病继发于淋巴结炎症性病变,淋巴结窦的血管转化和淋巴结血管肌瘤性错构瘤均由淋巴回流受阻引起,且两者具有伴发的特点。
Purpose Lymph node angiomyolipoma (AHL) rare, in order to improve the understanding of the disease, a case of lymph node myoma of hamartoma was discussed. Methods Histopathological features of the tumor were observed, immunohistochemical staining and Masson trichrome staining and silver staining, combined with review of the literature. Results Microscopic lymph node part of the structure survived, showing a small amount of lymphoid sinusoid and lymphoid follicles and scattered focal accumulation of lymphocytes, residual lymphoid tissue and more located in the lymph node under the capsule or marginal zone. The parenchyma of the lymph nodes is replaced by blood vessels, smooth muscle and fibrous tissue, but no bundle of cells or smooth muscle bundles are formed. There are a large number of hyperplasia of thick-walled blood vessels in the lymph nodes, and to the substantial extension, the extension of the vessel wall thickness by thinning, the vessel lumen gradually smaller, around the vascular hyperplasia of smooth muscle cells can be seen around. Some interstitial fibrosis, accompanied by collagen, visible thinner collagen fibers, fibroblasts and proliferative smooth muscle sometimes difficult to distinguish. Immunohistochemistry: CD34 (+) of vascular endothelial cells, SMA and desmin (+) of peripheral vascular spindle cells, HMB45, ER and PR (-). Masson trichrome staining: The collagen fibers and mucus are blue, and the myofibers that are not bundled between collagen fibers are red. Silver staining showed remnants of lymphoid tissue reticular fibers. Conclusions The disease is secondary to inflammatory lesions of lymph nodes. The vascular transformation of lymph nodes and the myoma of lymphatic vessels are caused by the obstruction of lymphatic drainage. Both of them have concomitant features.